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I was seventeen when I experienced my first panic attack, a psychiatric episode of intense anxiety and panic that can include

• nausea/vomiting
• a frightening sense of unreality (derealization)
• disassociation
• dizziness/lightheadedness
• sweating or shaking
• tingling
• sharp chest pain

and usually lasts for 5-30 minutes (though I can guarantee it feels like a lot more!). The fear was so intense that I dissociated – I could not tell where or who I was–and that in itself was frightening. My ears rang and I gagged multiple times. I just remember this overbearing, suffocating sense of: the world is coming to an end. The mental anguish was so severe that it felt like my worst nightmare had come true. Even when the anxiety finally plateaued about half an hour later, I was not the same for days afterward–I couldn’t sleep, eat, or function properly–and every time I was alone, I feared another attack would strike (this is very common after someone’s first panic attack).

After years of struggling with undiagnosed Generalized Anxiety Disorder (GAD), an anxiety disorder in which the sufferer experiences constant and agonizing worry pretty much constantly, my anxiety refused to be repressed. Now there was no denying it.

Here’s what living with GAD feels like, but constantly:

• The feeling when the subway doors close before you can hop in
• When you’re tipping back your chair and about to fall
• You have just gotten very upsetting news
• It’s your dream job interview in 5 minutes and you’re underprepared
• You have just been publicly humiliated
• You are running from a bull

All of that is pretty exhausting, so symptoms of fatigue, tiredness, and irritability are pretty common symptoms.

My above recollection, written months after the incident, may seem dramatic. As I later learned, most panic attacks aren’t as severe as my first. Sometimes, you can sit quietly in a classroom, praying panic away as your palms melt into puddles of sweat and your heart loses its trochaic rhythm. I have found that the more severe the panic, the harder it is to hide.

Anxiety & your nervous system

By its definition, anxiety is a “glitch” of your nervous system, affecting parts of the brain such as the amygdala and the rest of the limbic system. The symptoms of panic all serve a biological purpose — for example, your heart races to ensure that you have enough blood flow in your arms and legs to fight off an imagined predator – and range from uncomfortable to severe. And sometimes, extreme, untreated anxiety can confuse your nervous system. Rarely, this can lead to more long-term symptoms of illness similar to ones you would find in a panic attack.

Someone related to me (anxiety is genetic!) started experiencing “vomiting and presyncope,” to the point where she couldn’t get out of bed or sleep two summers ago. “I also couldn’t keep any food down, but no one could figure out why. I just continued to lose weight and Google frantically, imagining the worst.”

After her doctor ordered multiple panels of blood work and sent her to various specialists, they all concluded that her symptoms likely stemmed from severely disordered anxiety. “Once people understood that I was feeling sick because of a mental illness, the difference was shocking,” she admits. “Any sympathy they had completely washed away, and it was almost like the very physical manifestation disappeared in their eyes — nobody asked how I was feeling anymore. Some religious figures in my community suggested that my anxiety was a result of a lack of faith. It was pretty shocking.”

*Name omitted for privacy.

After getting diagnosed with anxiety and OCD, I started taking Lexapro, an antidepressant commonly used off-label for anxiety, and found much relief. However, medication is not a cure-all and anxiety is a life-long diagnosis. In all likelihood, I will struggle with disordered anxiety for the rest of my life. Drugs like Gabapentin and Propranolol help for acute, short-term anxiety during panic attacks. Speak to your psychiatric care provider about what could work best for you.

The Physiology of GAD

Doesn’t everyone have anxiety?

Anxiety is a normal (and even essential) part of modern life, so it can be challenging to understand why a common and often adaptive human emotion can be considered a condition. However, disordered anxiety is not even comparable to feeling a little nervous while running late to school, or before a final. Disordered anxiety is characterized by persistent and excessive feelings of anxiety, of which the sufferer usually feels that he or she has little control over. By definition, disordered anxiety is not just a passing emotion or temporary reaction – it is a debilitating physical and mental condition.

There are several types of anxiety disorders. Unlike social anxiety or specific phobias, this disorder causes constant worry about nothing in particular–what Freud called “free-floating anxiety.” In fact, many people with this kind of anxiety often are not sure themselves why they are so anxious. To further complicate matters, the human body can not distinguish between excess cortisol (a stress hormone) that is being pumped through the body for no reason or as a reaction to a bear chase. Regardless of the validity of the reason for one’s unease, any extreme anxiety triggers the body’s fight-or-flight reaction. This is our body’s natural evolutionary mechanism against threats. Because of changes that are spurred by this reaction, several unpleasant physical symptoms can arise.

The strangest possible sensations can be caused by anxiety.

I’ve had eye twitching, muscle cramps, and spots in my vision.

–Katya

The first mechanism through which the body tries to protect itself from a perceived threat is through diverting blood flow towards the arms and legs. In theory, this would strengthen the endangered person’s arms and legs, helping them run away from or fight off a potential threat. However, there is no threat, and this fast redirection of blood from the brain can lead to extreme lightheadedness and dizziness (feeling like the room is spinning or that the floor is moving underneath you). Other anxiety-related causes of this symptom are temporarily increased blood pressure (the result of a rapidly beating heart) and heart palpitations. It is easy to see how severe wooziness and dizziness reinforce anxiety, thus creating a vicious cycle.

The hormones that are released during this reaction also cause a response in the gut, which is often referred to as the second brain (ever heard the phrase “gut-brain axis”?). The changes that result from this can lead to nausea, vomiting, and stomach cramps. These symptoms can occur in an acute onset of anxiety (also known as a panic attack) or chronically. This can have a significant impact on appetite and weight.

Anxiety feels like I was just punched in the face all day, every day.

–Dorin

Although anxiety can cause tens of symptoms, the last one I will discuss is numbness and tingling. As a reaction to stress, blood vessels constrict. This can cut off blood supply to certain body parts, usually the extremities, leading to strange tingling or numbness feelings that can be very unsettling. But this sensation can be felt anywhere in the body, including on the face. This can make the person experiencing it feel even more edge because it often leads people to wonder if something is medically wrong with them.

Treatment for anxiety can include CBT therapy, medication and a healthy lifestyle. CBT works by reframing the negative thought processes that contribute to anxiety. Medications such as SSRIs can help prevent serotonin from being excessively reabsorbed into the neurons in the brain. Additionally, a healthy lifestyle is key for managing stress for anyone, and especially for stress associated with an anxiety disorder. This includes drinking adequate water, eating a proper balance of fruits, vegetables, proteins, and carbs, and exercising at least a few times a week.

Anxiety is not necessarily preventable, but it can still be managed very effectively. This is because it is usually caused mostly by a combination of genetic, biochemical, and personality factors, all over which a person has no control.

Other anxiety disorders

GAD isn’t the only anxiety disorder. Anxiety disorders include:

Composed of obsessions & compulsions (example: you can be obsessed with preventing a fire, so your compulsion would be checking your stove tens of times at night)

1. Post Traumatic Stress Disorder:

Triggered by witnessing a traumatic event: flashbacks, severe anxiety, uncontrollable thoughts, rumination, nightmares

2. Social Phobia:

The irrational fear of being publicly humiliated or being seen as vulnerable or misunderstood

3. Other phobias (ex: thalassophobia, emetophobia):

A specific, highly intense fear of one thing, like vomiting

4. Panic disorder:

Repeated episodes of panic attacks lasting from 5-30 minutes

My best friend lives with OCD. Here’s what she said she would want someone who calls it an “organizing disorder” to know:

The 24/7 anxiety and constant compulsions made me want to scream. I’ve rocked on the floor freaking out and I’ve gone through over 100 disposable gloves a week. I’ve destroyed my hands for weeks and avoided so much. I’ve taken medications that gave me horrible side effects and gone through multiple bottles of body wash in a week. That’s OCD.

–Callie

I also spoke to someone diagnosed with social phobia (or social anxiety disorder) who summed it up well:

I have Social Anxiety Disorder, which makes a regular day tough. Even when I know all the answers, I am terrified to raise my hand, as if everyone is going to start laughing at me the moment I open my mouth.

–Sara W.

My personal experience with GAD is that it feels like living on the edge. It feels like your most stressful day of the year, but every day. Any external factor–like running late, a family member not responding to your phone call–is enough to trigger an anxiety or panic attack, sending you into a spiral of struggle that is hard to break out of and often includes full-fledged physical symptoms. Simply, it is already too much–and the tiniest thing can set us fully over the edge.

What happens at the psychiatrist?

I avoided getting diagnosed with anxiety for years because of stigma and fears of reaching out for help. Now, I wish I had reached out before the disorder had fully burgeoned, because the consequences are long-term.

At your appointment, the doctor is interested in learning about what your day-to-day life is like and how your symptoms impact your daily activity. If you think you have anxiety, you can take the GAD-7 to see if you should visit a psychiatrist. Click here to take the questionnaire.

As tempting as it is, try not to self-diagnose! Disorders can be very closely related to each other. For example, I had no idea I had OCD in addition to anxiety until I was diagnosed. Similarly, bipolar disorder can closely mirror depression, and it is important that you get the correct diagnosis and treatment because what works for one disorder may be detrimental to another one. However, your experience is valid. If you think you meet the criteria for a specific diagnosis, you can try saying to the doctor, “I’ve done some research on ____ and I think I have it because _____. What do you think?”

What not to say, and what to try instead:

• Don’t worry. (Oh my god, I actually never thought of that!!)
• Pray more. (Anxiety is a health condition, not a lack of faith).
• Really, what’s the worst case scenario? (Um… you don’t want me to answer that)
• Give all your anxiety away to God. (Remind me to throw out my medication!)
• Relax more! (I can’t).
• Everyone has anxiety these days! (Exactly, and I have an anxiety disorder).
• I have anxiety too– during finals I get so stressed. (It feels like finals week every week for us).
• At least it’s not… (pro tip: don’t ever say this to anyone about anything).

What to try instead:

• What are you thinking about? Only ask if you care to listen!
• What are you currently interested in? We often live a stressful existence and talking about something exciting can be a great distraction.
• What do you need to hear right now? Being a good friend shouldn’t be guesswork.
• You’re doing great. I am so proud of you. What everyone needs to hear!
• I noticed that you’re struggling. Just thought I’d let you know that I care!

During a severe panic attack, your loved one may be too breathless or disassociated to carry on a conversation. Try saying:

• “It always ends.”
• “You will be okay.”
• “You will be calm again.”
• “Anxiety does not mean danger.”
• “You’re safe.”
• “I am right here.”
• “Can you tell me where we are? What’s your favorite color?” (or other distracting questions)

Or try:

• Setting a timer for 30 minutes and holding it within their view.
• Hand them a wet washcloth to put on their face.
• Hold their hand if they want that.
• Administering (prescribed) anxiety medication.
• Calling someone they trust.
• Sit silently beside them and appear to be calm, even if you feel scared or worried.

What to remember:

• You are not alone. Millions of Americans suffer from GAD.
• There is treatment: therapy and medication can do wonders.
• It’s not your fault. The origins of GAD are genetic, neurobiological, and environmental–not your faith or lack thereof.
• Find a support group. Having a friend who suffers from OCD helps me feel understood. Hopefully none of your friends struggle with mental illness, but there are support groups for all conditions you can access through your local community center.
• Your anxiety does not define you! What else makes you awesome?

Stigma and accommodations

Panic attacks can induce agoraphobia, wherein the sufferer acquires a fear of being in public due to worries that a panic attack will strike. For months after my first panic attack, the thought of even heading to the Target down the street triggered sweaty palms.

I personally struggled mightily to receive accommodations at my small private school that might seem commonplace. For example, during the height of my anxiety, I asked to opt out of a three-day overnight trip, and was perceived to be having a bad attitude by my belligerent administration. When I asked for exemption from an amusement park trip during a particularly tough time, I was informed that I was being snobby by refusing to join my classmates, and my principal insinuated that I would never be a good mother and wife–a sexist diversion from the accommodations that would make my life a lot easier. When in doubt:

• Understand that you can’t understand. And then ask them to explain (and listen).
• Exercise empathy. How would you want to be treated?
• Don’t try to be “helpful.” It’s not your job to help someone else beat their anxiety (unless they’ve hired you). As a school administrator, parent, or friend, don’t try to “fix” people by forcing them to do things they find excruciating.
• Refer to our article on self-advocacy for tips on receiving the accommodations you may need for your mental health condition.

Final pointers:

• Anxiety is not curable, but treatment can help.
• Anxiety has nothing to do with faith–and asking for accommodations does not make you a bad person.
• Mental suffering is just as valid as physical suffering.
• Exercise, medication, talk therapy, and support groups can be very helpful in living your best life.